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Results for “CHOLECYSTECTOMY”

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PubMed1994

The stress response to laparoscopic cholecystectomy: investigation of endocrine parameters.

Laparoscopic cholecystectomy, as a typical example of minimal invasive surgery, is associated with low complication rates and minimal patient discomfort, and provides the same safety as conventional cholecystectomy. In the present prospective observational study, endocrine parameters as indicators for stress response were measured. We investigated 53 patient with laparoscopy cholecystectomy and 12 patients with conventional cholecystectomy. Blood samples were taken pre-, peri-, and postoperatively for measurement of ACTH, cortisol, prolactin, and growth hormone. General anesthesia followed a standardized protocol. The increase in all stress hormones did not differ between patients in the two groups, and was comparable with that reported in the literature and the findings of our own previous studies in patients undergoing conventional cholecystectomy and elective colon resection. We conclude that laparoscopic cholecystectomy is associated with a pronounced endocrine stress response that does not account for the observed differences in the peri- and postoperative complication rate or patient comfort.

Adrenocorticotropic Hormone↗

PubMed1992

A clinical decision analysis to assess the value of laparoscopic cholecystectomy in the treatment of gallstone disease.

Laparoscopic cholecystectomy has been introduced for gallstone therapy and its use appears currently to be spreading very rapidly. A clinical decision analysis was performed to assess this new technique by quantitative comparison with other therapeutic modalities. A decision tree-based state transition model implemented to simulate a five-year period of follow-up was constructed. Non-surgical treatments were superior to surgical treatments in enhancing both life expectancy and quality-adjusted life expectancy on the basis of the optimal indications; one radiolucent stone < 2 cm for extracorporeal shock-wave lithotripsy and multiple floating stones for oral dissolution therapy respectively, especially in the elderly. Laparoscopic cholecystectomy was superior to open cholecystectomy in enhancing the quality of life for all eligible patients. Sensitivity analysis revealed that a higher incidence of the bile duct injury resulting from laparoscopic cholecystectomy would result in a poorer quality-adjusted life expectancy. The results of the analysis suggest the following. Nonsurgical treatments are acceptable alternatives to surgery on the basis of their optimal indications. Laparoscopic cholecystectomy has an advantage over open cholecystectomy in enhancing the patient's utility, and appears to be an attractive therapeutic modality. A proper training program is necessary to ensure the quality of this procedure in order to maintain its advantage.

Adult↗

PubMed2000

Laparoscopic or open cholecystectomy in patients with sickle cell disease: which approach is superior?

OBJECTIVE: To compare laparoscopic with open cholecystectomy in patients with sickle cell disease. DESIGN: Retrospective clinical study. SETTING: University hospital, Greece. SUBJECTS: 41 patients (22 men and 19 women) with sickle cell disease had laparoscopic cholecystectomy between September 1991 and June 1998. Each patient was matched for age, sex, year of operation, and number of preoperative transfusions with control patients with sickle cell disease who had open cholecystectomy. MAIN OUTCOME MEASURES: Duration of operation, postoperative stay in hospital, incidence of complications, and conversion to open operation. RESULTS: The mean operation time was 81.4 min (range 55-125) for open cholecystectomy and 64.2 min (range 45-90) for laparoscopic cholecystectomy (p < 0.01). Complications occurred in 5% (2/41) of the patients in the laparoscopic group and in 20% (8/41) of the patients in the open group (p = 0.04). The mean length of stay in hospital was 5.6 days (range 3-9) in the open group and 2.7 days (range 2-5) in the laparoscopic group (p < 0.01). Conversion to open operation was necessary in 2 (5%) patients. CONCLUSIONS: Laparoscopic cholecystectomy resulted in a shorter hospital stay with fewer postoperative complications than open operation in patients with sickle cell disease and may be the procedure of choice in the treatment of cholelithiasis in such patients.

Adolescent↗

PubMed2000

Comparison of postoperative acute-phase reactants in patients who underwent laparoscopic v open cholecystectomy: a randomized study.

PURPOSE: We investigated the effect of laparoscopic v open cholecystectomy on acute-phase reactants. PATIENTS AND METHODS: Fifty patients were randomized to laparoscopic (Group 1) and 50 to open (Group 2) cholecystectomy. Preoperative and postoperative values for acute-phase reactants (ceruloplasmin, fibrinogen, Westergren sedimentation rate, alpha-1-antitrypsin, haptoglobin, and C-reactive protein) in blood samples were compared. RESULTS: Acute-phase reactants and length of hospitalization were significantly lower in patients who underwent a laparoscopic cholecystectomy than in those who underwent an open cholecystectomy. CONCLUSION: Laparoscopic cholecystectomy appears associated with a less intense stress response and less tissue damage than open cholecystectomy.

Acute-Phase Reaction↗

PubMed1992

Laparoscopic versus open cholecystectomy and the need for a randomized trial: a survey of surgeons and ethical committees in the British Isles.

A questionnaire on the necessity and ethics of a randomized trial to compare laparoscopic cholecystectomy and open cholecystectomy was sent to 200 randomly selected surgeons in the British Isles, of whom 117 replied. Of these, 58% thought that a trial was needed to compare laparoscopic cholecystectomy with open cholecystectomy by either minilaparotomy or the conventional approach. Nearly half (45%) expressed interest in participating in such a trial. A hypothetical protocol for a trial was sent to 40 ethical committees; 25 gave approval and only 3 considered that a trial was unethical (12 refused to comment). This survey shows wide support for a trial comparing laparoscopic cholecystectomy with open cholecystectomy.

Attitude of Health Personnel↗

PubMed1995

General stress response to conventional and laparoscopic cholecystectomy.

OBJECTIVE: In many retrospective and prospective observational studies, laparoscopic cholecystectomy (LC) compares favorably with conventional cholecystectomy (CC), with respect to length of hospital stay, postoperative pain, and pulmonary function, indicating a diminished operative trauma. Comparison of laboratory findings (stress hormones, blood glucose, interleukins) are a possibility to objectify stress and tissue trauma of laparoscopic and conventional cholecystectomy. SUMMARY BACKGROUND DATA: Major body injury, surgical or accidental, evokes reproducible hormonal and immunologic responses. The magnitude of many of these changes essentially is proportional to the extent of the injury. METHODS: In a prospective study, biochemical stress parameters were measured in the blood of patients undergoing elective cholecystectomy because of symptomatic cholecystolithiasis. Patients with acute cholecystitis, pancreatitis, choledocholithiasis, or malignant disease were excluded. Values from 40 patients after LC and from 18 patients after CC were compared. Both groups had similar patient characteristics, baseline values, and perioperative care, except for deeper anesthesia during CC. RESULTS: On postoperative day 1, epinephrine (p = 0,05), norepinephrine (p = 0.02), and glucose (p = 0.02) responses were higher after CC. Two days postoperatively, norepinephrine remained higher after CC (p < 0.01). Interleukin-1 beta responses were higher during (p < 0.01) and 6 hours after CC (p = 0.03). Interleukin-6 responses were higher 6 hours (p = 0.03), 1 day (p = 0.02), and 2 days (p < 0.01) after CC. CONCLUSIONS: The results show significant lower values of intraoperatively and postoperatively measured epinephrine, norepinephrine, interleukin-1 beta, and interleukin-6 in patients with laparoscopic cholecystectomy, indicating a minor stress response and tissue trauma in this group of patients. The results correspond to the favorable results of most other trials evaluating clinical aspects of laparoscopic cholecystectomy.

Adult↗

PubMed2006

Outcome of cirrhotic patients undergoing cholecystectomy: applying Bayesian analysis in gastroenterology.

BACKGROUND AND AIM: Cholelithiasis is a common finding in patients with cirrhosis. Previous studies showed that open cholecystectomy (OC) carries a high risk of postoperative complications and deaths in cirrhotic patients. Laparoscopic cholecystectomy (LC) has significantly decreased hospital stay and postoperative morbidity in non-cirrhotic patients. The aim of this study was to evaluate the outcomes of cirrhotic patients after LC and OC in a tertiary center. METHODS: The outcomes of 33 cirrhotic patients matched by age and sex to 66 non-cirrhotic controls who underwent cholecystectomy were assessed using Bayesian analysis. Both non-informative and informative priors were used to calculate posterior distributions for parameters under investigation. RESULTS: Twenty-four (72%) cirrhotic patients had LC and 9 (27%) OC. A similar percentage of patients in the control group underwent LC (78%) and OC (21%). Emergent cholecystectomy was not different between cirrhotic and controls (95% credible interval [CrI]-0.35, 0.02). Mean blood loss, duration of surgery and conversion rate was not different between cirrhotic and controls, but cirrhotic patients had a longer length of hospital stay than controls (CrI 0.88, 4.71). Cirrhotic patients undergoing LC had lower volume of blood loss (CrI -363.85 mL, -49.28 mL), shorter duration of surgery (CrI -79.82 min, -19.74 min), lower amount of intravenous fluid during surgery (CrI -1532.9 mL, -495.4 mL) and shorter hospital stay (CrI -11.14 days, -1.20 days) than cirrhotic patients undergoing OC. Child-Pugh class B class and admission diagnosis of biliary pancreatitis were associated with a longer hospital stay. CONCLUSION: Laparoscopic cholecystectomy is a safe and effective alternative to OC in Child-Pugh class A and B cirrhotic patients undergoing elective or emergent cholecystectomy. Although outcomes of cirrhotic patients undergoing LC and OC in a tertiary center are not different, LC is associated with less intraoperative bleeding, shorter duration of surgery and fewer days of in-hospital care.

Adult↗

PubMed2000

Effect of cholecystectomy on gastroesophageal and duodenogastric reflux.

OBJECTIVE: The majority of patients experience resolution of their symptoms after cholecystectomy, but a minority either find their symptoms unchanged or complain of new upper GI symptoms. It has been suggested that the effect of cholecystectomy on upper GI motility, sphincter function, or bile delivery may account for these postoperative symptoms. We aimed to determine whether cholecystectomy affects gastroesophageal reflux or duodenogastric reflux by using 24-h ambulatory pH and gastric bilirubin monitoring before and after surgery. METHODS: Seventeen symptomatic patients with gallstones underwent 24-h ambulatory esophageal and gastric pH-metry and gastric bilirubin monitoring. Helicobacter pylori status was ascertained in all patients by 14C urea breath test and serology. Combined pH and bilirubin monitoring was repeated 3 months after cholecystectomy. Eleven healthy subjects served as a control group. RESULTS: Three (17%) patients complained of persistent or new symptoms after surgery, whereas 14 (83%) patients were asymptomatic. Two patients (12%) underwent open cholecystectomy, and (88%) had the operation performed laparoscopically. No significant differences were detected in esophageal acid exposure (pH < 4), gastric alkaline shift (pH > 4), or gastric bilirubin exposure (absorbance > 0.14) after surgery. Three (17%) patients tested positive for Helicobacter pylori; the presence of infection did not appear to affect pre- or postoperative values. CONCLUSIONS: Cholecystectomy does not result in increased bile reflux into the stomach or increased gastroesophageal acid reflux. Those patients who had increased postoperative duodenogastric reflux were entirely asymptomatic. The symptoms of postcholecystectomy syndrome are unlikely to be related to increased duodenogastric reflux after surgery.

Adult↗

PubMed2006

First results after introduction of the four-armed da Vinci Surgical System in fully robotic laparoscopic cholecystectomy.

BACKGROUND: Laparoscopic cholecystectomy offers less post-operative pain, less complications, and faster recovery compared with open cholecystectomy. However, laparoscopic surgery can be demanding because of several technical drawbacks. Robotic surgery allows dexterity skills to be performed faster and shortens the learning curve, possibly leading to faster and safer laparoscopic surgery. METHODS: In this paper, we report the results of our first 12 cases of fully robotic laparoscopic cholecystectomy using the da Vinci Surgical System, comparing them with 12 cases of conventional laparoscopic cholecystectomy. Using a fourth arm in robotic laparoscopy enables the surgeon to perform surgery without the use of a tableside assistant, leading to non-tiring, tremble-free assistance and reducing salary costs. Primary end points are operating time and costs. Secondary end points are operative complications and duration of admission. RESULTS: Fully robotic cholecystectomy was completed in all 12 cases without increased complication rate and without conversions. However, robotic assistance results in an increased overall operating room stay of 31 min and increased costs of EUR 1,180.62. CONCLUSION: Fully robotic laparoscopic cholecystectomy is safe and feasible but seems more expensive and time consuming at this moment.

Adult↗

PubMedDate not supplied

Prophylactic cholecystectomy with open gastric bypass operation.

BACKGROUND: There has been controversy regarding prophylactic cholecystectomy with Roux-en Y gastric bypass. The results reported in open cases showed no significant increase in morbidity by the addition of cholecystectomy. A series of open cases were reviewed to evaluate the propriety of prophylactic cholecystectomy. METHOD: The records of 141 patients undergoing cholecystectomy during open gastric bypass were reviewed, documenting age, ultrasound findings and pathology. RESULTS: Of the 141 cases analyzed, the incidence of gall-bladder pathology was 80%. 24 (17%) of the 141 patients were noted to have gallstones on preoperative ultrasound examination, and 3 (2%) showed polyps. 9 patients (6%) had gallstones at surgery with normal ultrasound. Cholesterolosis was present in 52 cases (37%) and chronic cholecystitis in 25 cases (18%). CONCLUSION: In view of the high incidence of gall-bladder disease (80%) already present in morbidity obese patients undergoing gastric bypass and the lack of significant morbidity in open surgery with prophylactic cholecystectomy, the addition of prophylactic cholecystectomy appears appropriate.

Adolescent↗

PubMed2006

Is routine cholecystectomy necessary at the time of Roux-en-Y gastric bypass?

BACKGROUND: Morbid obesity is associated with an increased incidence of gallstones. Rapid weight loss, as occurs after Roux-en-Y gastric bypass (RYGBP) may also increase gallstone development. Standard surgical treatments for gallbladder disease and its complications might be more difficult following RYGBP. Controversy still exists whether prophylactic cholecystectomy is indicated at the time of RYGBP. METHODS: Retrospective analysis was performed on a database of 535 patients who underwent RYGBP for morbid obesity during a 5.5-year period. Patients were followed and medical records were reviewed. Ursodeoxycholic acid was not prescribed following surgery. RESULTS: 8% of patients had had cholecystectomy before the RYGBP. 75 of 492 patients (15%) were found to have gallstones at RYGBP, and cholecystectomy was performed at the same time. 3 of these patients had bile leaks but only 1 required further intervention (percutaneous transhepatic drainage for 3 weeks). Following RYGBP, 14 patients (3%) have required cholecystectomy for symptomatic cholelithiasis in the postoperative period. All were performed laparoscopically and without complication. CONCLUSIONS: Symptomatic gallbladder disease after RYGBP has not been frequent. Prophylactic cholecystectomy for a normal gallbladder is not necessary at the time of RYGBP. Patients without biliary tract symptoms may not require routine preoperative sonogram. If an abnormal gallbladder or gallstones are found at the time of an RYGBP operation, concomitant cholecystectomy should be considered.

Cholecystectomy↗

PubMedDate not supplied

[The influence of laparoscopic cholecystectomy vs laparotomy on the monocyte antigen expression (HLA-DR)].

It is well known that surgery significantly decrenses immune responses. Laparoscopic cholecystectomy (LC) is a so called "mini invasive" surgical presidia, and on the basis of this consideration we have investigated if and how the immune response is modified in patients after laparoscopic cholecystectomy compare to patients undergone open cholecystectomy. Immune-activity (neutrophils, total lymfocytes count, lymphocytes subpopulations, HLA-DR) was evaluated in 53 patients one day before surgery and p.o. after 1. 3 and 6 days; 26 patients underwent "open" cholecystectomy and 27 LC. One day after surgery patients with open cholecystectomy showed significant increase (p < = 0.05) of plasma neutrophils, while these parameters were almost unchanged in patients with L.C. Finally monocyte antigen HLA-DR was also reduced in patients with "open" cholecystectomy: in this group we also recorded 2 cases (7.6%) of respiratory tract infection. In conclusion LC, strongly reduces p.o. pain, hospitalization, promotes earlier recovery and return to normal activity, avoiding p.o. immunosuppression, mostly due to conservation of HLA-DR activity, with better p.o. morbidity compare to open surgery.

Adult↗

PubMedDate not supplied

[Prophylactic cholecystectomy for gallbladder calculosis].

Asymptomatic gallstones are defined as stones that have not caused biliary colics or other biliary symptoms. Some cross-sectional epidemiological screening studies have shown that as many as 66% to 77% of patients with gallstones are asymptomatic. Studies of natural history suggest that the cumulative probability of developing biliary colics after ten years ranges from 15% to 25%. None of the variables considered as possible modifiers of natural history, were found to be associated with an increased risk of incidence of biliary colics. Cholecystectomy is a vary safe treatment and is being performed with near zero mortality. Two are the possible strategies compared: prophylactic cholecystectomy with expectant management for silent gallstone disease. Consideration of survival and monetary costs disfavors prophylactic cholecystectomy. The results of laparoscopic cholecystectomy compare favorably with those of open cholecystectomy with respect to mortality, complications, length of hospital stay, cosmetically satisfactory and financial benefits. Patients with asymptomatic stones in the gallbladder require neither surgical nor medical treatment. Consideration of monetary costs disfavors prophylactic cholecystectomy: a waiting attitude has the advantage of lowering the sanitary costs also for the high incidence of silent gallstones in our population.

Cholecystectomy↗

PubMed2000

Laparoscopic cholecystectomy in cirrhosis: contraindication or privileged indication?

Until recently, cirrhosis has been considered to be an absolute or relative contraindication of laparoscopic cholecystectomy. An evaluation of benefits and risks of laparoscopic cholecystectomy in the treatment of gall bladder lithiasis in cirrhotic patients is presented. Thirty-three consecutive laparoscopic cholecystectomies in patients with cirrhosis were performed between March 1990 and March 1997. During the same period, no open cholecystectomy was performed in patients with cirrhosis. There was no morbidity or mortality; the conversion rate was 6% (2/33). No patient received blood transfusion, and the mean hospital stay was 2.8 days. These results favorably compare with the results of open cholecystectomy. Specific advantages of laparoscopic cholecystectomy in patients with cirrhosis include the absence of wound infection and a lower rate of postoperative hepatic failure. Finally, laparoscopic surgery reduces the risk of viral contamination (the hepatitis B virus, the hepatitis C virus, or the human immunodeficiency virus) of the surgical staff.

Adult↗

PubMed1992

Laparoscopic cholecystectomy: a review of 12,397 patients.

We reviewed the cumulative experience with laparoscopic cholecystectomy reported in the surgical literature, including 12,397 patients selected to undergo laparoscopic cholecystectomy, 95% of which were performed on an elective basis. Although the indications for operation varied, 90% of patients had evidence of cholelithiasis and biliary colic. Conversion to open cholecystectomy was required in 534 patients (4%); of these, 52% were converted because of acute or chronic inflammation or adhesions. Laparoscopic cholangiography was attempted in 3,696 of 9,231 patients (40%) and was successful in 84%. The incidence of major bile duct injury, minor bile duct injury, bile leak, and overall morbidity was 0.3%, 0.1%, 0.4%, and 4%, respectively. The mortality rate was 0.08%. Results from individual reports indicate that 54% to 98% of patients were discharged on the 1st or 2nd postoperative day, and 77% to 98% returned to full activity within 7 to 14 days. The incidence of bile duct injury, overall morbidity, and mortality compare favorably with published reports for open cholecystectomy. The collective data would also indicate that laparoscopic cholecystectomy is a safe and efficacious procedure that offers a viable alternative to conventional cholecystectomy.

Cholangiography↗

PubMed1992

Serum interleukin-6 and C reactive protein responses in patients after laparoscopic or conventional cholecystectomy.

OBJECTIVE: To investigate the acute phase inflammatory response to surgical trauma after laparoscopic and conventional cholecystectomy. DESIGN: Prospective open study. SETTING: University Hospital in The Netherlands. SUBJECTS: 21 patients with symptomatic cholelithiasis admitted for elective cholecystectomy who had had no previous upper abdominal operations. INTERVENTIONS: 12 patients underwent conventional, and 9 patients laparoscopic, cholecystectomy. Circulating interleukin-6 (IL-6) and C reactive protein concentrations were measured 6, 12, 24 and 48 hours after operation. MAIN OUTCOME MEASURE: Changes in IL-6 and C reactive protein concentrations, and comparison of operative blood loss and length of stay in hospital. RESULTS: Those treated by laparoscopic cholecystectomy lost significantly less blood (median 60 compared to 100 ml) and spent significantly fewer days in hospital (median 2 compared with 7 days), (p < 0.01 in each case). The only changes in circulating IL-6 concentrations were seen in patients over the age of 60 years who underwent conventional cholecystectomy. There were significant differences in C reactive protein concentrations between the two operations at both 24 and 48 hours after the operation (p < 0.01 in each case). CONCLUSION: We conclude that laparoscopic cholecystectomy reduces the acute phase inflammatory response compared with the conventional operation; there seems to be no relevant correlation between plasma concentrations of IL-6 and C reactive protein; the presence of IL-6 does not affect the response of C reactive protein to trauma; and the response of IL-6 to trauma is age dependent.

Adult↗

PubMed2005

[Cholecystectomy in Denmark 1989-2003].

INTRODUCTION: The aim of this study was to describe the cholecystectomy rate in Denmark in the last 15 years, since the introduction of laparoscopic cholecystectomy might have had an influence on it. MATERIALS AND METHODS: An analysis was done of data from the mandatory Danish National Patient Registry, which covers all public hospitals in Denmark. All cholecystectomies performed from 1989 to 2003 in the various hospitals were registered. Open and laparoscopic operations were registered separately. In addition, the number of patients who were operated on for acute cholecystitis from 1996 to 2003 was registered. RESULTS: An increase in the cholecystectomy rate was observed, from 67/100,000 inhabitants in 1989 to 143/100,000 inhabitants in 2003 (p < 0.05). The increase was due mainly to the number of laparoscopic procedures, which comprised 81% of all cholecystectomies in 2003. The proportion of patients who were operated on for acute cholecystitis decreased from 14% in 1996 to 12% in 2003 (p < 0.05). DISCUSSION: The increasing cholecystectomy rate in Denmark from 1989 to 2003 is probably due to the fact that more patients are having surgery for painful gallbladder stones.

Cholecystectomy↗

PubMed1994

Micro- and modern minilaparotomy cholecystectomy.

The issue minilaparotomy cholecystectomy has not been clearly defined. For the purpose of discussion, microlaparotomy cholecystectomy (MLC) is less than 4 cm coeliotomic incision, modern minilaparotomy cholecystectomy (MMLC) from 4.1 to 6 cm and the conventional minilaparotomy cholecystectomy (CMLC) from 6.1 to 8 or 10 cm long abdominal incisions. The object of our paper is a presentation of our experiences during 607 MLC and MMLC developed as alternatives to laparoscopic cholecystectomy (LC) as well as conventional cholecystectomy (CC). There were 435 women and 172 men. The youngest patient was 15 years old, and the oldest 87 years old. (Death rate: 0.16, early reoperation: 0.49%, conversion rate: 0.49.) Only 156 of the 607 patients were designated as simple cases. The most complicated patients were encountered in the obstructive cholecystitis group. The 9 significant complications of the 11 encountered during 607 MLC and MMLC belonged to the delayed group. MLC and MMLC did not require sophisticated expensive technology or specialized skill, and therefore it could be available in any general hospital. The MLC and MMLC are designated as safe, less expensive alternatives to LC as well as CC.

Adolescent↗